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Long-Term Outcomes After Stenting of Bifurcation Lesions With the "Crush" Technique

Predictors of an Adverse Outcome

Angela Hoye, MB ChB, PhD^_*, Ioannis Iakovou, MD, Lei Ge, MD, Carlos A.G. van Mieghem, MD^_*, Andrew T.L. Ong, MD^_*, John Cosgrave, MD, Giuseppe M. Sangiorgi, MD, Flavio Airoldi, MD, Matteo Montorfano, MD, Iassen Michev, MD, Alaide Chieffo, MD, Mauro Carlino, MD, Nicola Corvaja, MD, Jiro Aoki, MD^_*, Gaston A. Rodriguez Granillo, MD^_*, Marco Valgimigli, MD^_*, Georgios Sianos, MD, PhD^_*, Willem J. van der Giessen, MD, PhD^_*, Pim J. de Feyter, MD, PhD^_*, Ron T. van Domburg, PhD^_*, Patrick W. Serruys, MD, PhD^_*,_* and Antonio Colombo, MD

^_* Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy

View larger version (69K): [in a new window]   Figure 1 The crush technique of bifurcation stenting. (A) Baseline angiogram with significant stenosis of the left anterior descending/first diagonal bifurcation. (B) Both vessels are wired, and both stents are positioned. A 2.5 x 12 mm Taxus stent is positioned in the side branch with its proximal part well within the main vessel; at the same time, a 3.0 x 24 mm Taxus stent is within the main vessel, ensuring it completely covers the proximal part of the side branch stent. (C) The side branch stent is deployed, and the balloon is withdrawn. (D) The stent in the main vessel is deployed. (E) Final result.

View larger version (9K): [in a new window]   Figure 2 Cumulative survival free of target lesion revascularization (TLR) and major adverse cardiac events (MACE) after bifurcation stenting with the crush technique.

View larger version (9K): [in a new window]   Figure 3 Cumulative survival free of target lesion revascularization (TLR) for patients treated with the crush technique of bifurcation stenting for a left main stem (LMS) lesion compared with those treated for lesions outside the left main stem (non-LMS).